INFECTIOUS DISEASES MCQ
1.
A patient is found to have Streptococcus bovis endocarditis. After appropriate treatment you should:
a.
b.
c.
d.
e.
f.
g.
h.
CT adrenals
Arrange dental review
Colonoscopy
Perform blood cultures
HIV serology
colonoscopy
small bowel series
iron studies
2.
A male in his 20's presents with a rash over his lumbar region. (Photo shown with lumbar Varicella zoster).
CD4+ count found to be 540, HIV +ve. Most likely course of disease would be:
a.
b.
c.
d.
e.
Recovery after 2 weeks
Prolonged neuralgic pain
Disseminated cutaneous disease
Disseminated systemic disease
Encephalopathy
3.
advice:
a.
b.
c.
d.
Hospital worker needle stick injury. Patient HIV negative, hepatitis B neg, Hepatitis C positive.
Comes for
lamivudine if develops hepatitis
immunoglobulin
interferon alpha if develops hepatitis
lamivudine
4.
A young man recently returned from Burma presents very unwell febrile with GCS of 7. Blood film has
falciparum malaria. Best treatment:
a.
b.
c.
d.
e.
quinine iv
chloroquine
mefloquine
doxycycline
fansidar.
5.
Risk of acquiring falciparum malaria is the greatest in:
a.
b.
c.
d.
e.
Papua New Guinea
Thailand
Africa
India
Burma
6.
HSV encephalitis best diagnosed with:
a.
b.
c.
d.
lumbar puncture
EEG
psychometric testing
MRI
7.
Proctoscopy shown in a young woman with blood y diarrhoea who for a week.
background mucosa with red and white patches. Management?
Picture shows black
a.
b.
c.
d.
colonoscopy
MC&S stool
metrorndazole
double contrast barium enema
8.
Older women who has asymptomatic UTI and has repeat urine sent.
gentamicin, norfloxacin, trimethoprim. Management:
a.
b.
c.
d.
e.
E Coli grown; WCC 60, sensitive to
oestrogen
norfloxacin
trimethoprim
gentamicin
nothing
9.
Patient with common variable immunodeficiency presents with pneumonia.
organism?
a.
b.
c.
d.
e.
What is the most likely
aspergillus
pneumococcus
mycoplasma
CMV
Pseudomonas
10.
Patient with pneumonia who had a fully sensitive pneumococcus. Day 5 gets worse. CXR: empyema. What
do you do?
a.
b.
c.
drain empyema
change to erythromycin
bronchoscopy
11.
A man spent time in ICU had been on TPN, had a pancreatic abscess debrided, and now develops back pain.
Unable to stand, unwell, WCC 13, Neutrophils 10.2, platelets 454. Xray shown, lateral view of lumber spine with
wedging and some process affecting 2 adjacent vertebrae (?osteomyelitis). Next investigation?
a.
b.
c.
d.
e.
technetium bone scan
gallium scan
MRI
CT guided biopsy
rnyelograrn
12.
Young women going to Nepal for 12 months, who is Mantoux negative. Best advice re management?
a.
b.
c.
d.
e.
isoniazid for 12 months
isoniazid for fevers and sweats
BCG vaccine
reassure
serial CXR
13.
HIV positive patient, syphilis treated with penicillin in 1995. Syphilis serology was 1:64 then 1:32 then 1:16
then back to 1:32, rest of serology was positive. Best management?
a.
b.
c.
d.
lumbar puncture
penicillin
nothing
repeat serology in 3 months
14.
The MMR (Rubella) vaccine is made up of:
a.
b.
c.
d.
e.
Live attenuated virus
Inactivated (killed) virus
Purified toxoid
Polysaccharide antigen
Rubella virus surface antigen
15.
Young patient with P. falciparum malaria (? falciparum more likely than vivax or ovale). The most likely
country to have recently travelled to:
a.
b.
c.
d.
e.
Papua New Guinea
India
Thailand
Zimbabwe
?European country
16.
Person with slide red cells with ring forms, some with more than 1 per cell. Obtunded. Best IV treatment:
a.
b.
c.
d.
e.
Quinine
Quinidine
Chloroquine
Mefloquine
Doxycycline
17.
A Streptococcus pneumoniae is found to have a MIC >1 (high level resistance). The most effective treatment
would be:
a.
b.
c.
d.
e.
Penicillin
Ceftriaxone
Vancomycin
Erythromycin
Ciprofloxacin
18.
Best indicator of progression to AIDS with HIV positivity:
a.
b.
c.
d.
e.
CD4+ count
serum neopterin
2 microglobulin
CD8+ count
HIV viral titre
19.
The treatment for adult meningitis is now a 3rd generation cephalosporin plus penicillin. The reason for the
addition of penicillin is:
a.
b.
c.
d.
e.
Listeria monocytogenes
E. coli
Haemophilus influenzae
Penicillin-resistant meningococcus
Pneumococcus
20.
Gonococcal infections can be treated with a stat dose of azithromycin, or a ten day course of doxycycline.
The reason for this difference is?
a.
increased serum half-life
b.
c.
d.
e.
increased intracellular half-life
post-antibiotic effect
increased bactericidal activity
? increased potency
21.
An HIV+ patient with a CD4+ count of 400 presents with a pneumonia. The most likely organism is:
a.
b.
c.
d.
e.
Tuberculosis
Pneumocystis carinii
Atypical mycobacterium
Streptococcus pneumoniae
Mycoplasma pneumoniae
22.
The mechanism of resistance of MRSA to methicillin is best characterised by:
a.
b.
c.
d.
e.
Increased efflux of antibiotic from the cell
Altered penicillin binding proteins
Chromosomally encoded -lactamase production
Deactivation of the drug
Plasmid-encoded -lactamase
23.
A female schoolteacher is travelling to Nepal to work for 12 months. The best evidence for prevention of
tuberculosis is with:
a.
b.
c.
d.
e.
Isoniazid prophylaxis
BCG vaccination
No treatment but advice concerning symptoms
Isoniazid empirically if fevers or night sweats
Wear a face mask
24.
A nurse receives a needle-stick injury from a patient who is found to be HIV -ve, Hepatitis B -ve and HCV
+ve. Apart from following her serologies you should:
a.
b.
c.
d.
e.
Administer pooled human immunoglobulin
Give interferon (?which one)
Give interferon if develops hepatitis
Administer lamivudine
Do nothing further
25.
An elderly gentleman has recent admission for bowel surgery, and received TPN during the admission. He is
readmitted soon after with back pain and fevers. (Xray shown with obvious discitis). The next investigation is:
a.
b.
c.
d.
e.
MRI
CT guided fine-needle aspirate
Blood cultures
Bone scan
ANCA
26.
Female with previous syphilis treated ? 3 years prior. Now asymptomatic. Given titres and fact that TPHA
and FTA-Abs +ve. Titres given 1:64, 1:32, one 1:16 then few 1:32's. Next step in management?
a.
b.
c.
d.
Treat with penicillin ?IM benzathine for 2 weeks
Lumbar puncture
Follow serology repeat 3 months
Another penicillin regimen
27.
Regarding intravenous lines
a.
b.
c.
d.
plastic cannulae have a lower infection rate than scalp vein needles
femoral vein cannulae have a lower infection rate than subclavian cannulae
bacteraemia is unlikely to be from the intravenous line if there is no sign of phlebitis
in the setting of bacteraemia cure necessitates removal of the line
28
Urine culture grows Klebsiella pneumoniae and shows the following:
Amoxicillin
Cefotaxirne
Irnipenem
Ciprofloxacin
Gentamicin
MIC
64
32
2
8
4
Interpretation
resistant
resistant
sensitive
resistant
resistant
Treated as a UTI, regarding therapy, which of the following are true:
a.
b.
c.
d.
Klebsiella likely to be Extended Spectrum  Lactamase producer
Gentamicin concentration of 4 will kill 99.9% of colonies
Gentamicin is half as good as Ciprofloxacin
Gentamicin would not be effective therapy in this UTI
29.
Indian man with TB. Commenced on therapy with Ethambutol, Rifampicin, Isoniazid and Pyrazinamide.
(Shown sensitivities - resistant to Isoniazid and Streptomycin, sensitive to others). This would indicate:
a.
b.
c.
d.
e.
pattern of resistance strongly suggestive of prior therapy in India
will need 4/52 isolation
short course of Rx not effective
second line drugs will be needed
current therapy will not be effective
30.
Infection complicating peripheral cannulae is proven to be  by:
a.
b.
c.
d.
e.
Elective as opposed to non-elective insertion
Arm vs leg
Antimicrobial ointment
Occlusive dressing
Resiting every 48 hours
31.
Young Pt in ICU following an MVA. Central line in situ. Develops fever and air space shadowing and is
treated accordingly (?Cefotaxirne) and improves but then relapses. CXR is unchanged, urine and blood show no
growth. Next best step:
a.
b.
c.
d.
e.
Remove central line and send for M, C & S
bronchoscopy
transtracheal aspirate via ETT
Increase antibiotics
Echo
32.
Which of the following statements regarding Mycobacterium avium complex (MAC) disease is INCORRECT:
a.
Only Pneumocystis carinii pneumonia and Kaposi's sarcoma are more frequent opportunistic diseases affecting
patients with AIDS.
Multiple drug resistance in MAC caused by the microbe cell envelope
b.
c.
d.
e.
Antimicrobial prophylaxis against MAC avium should be considered when the CD4 lymphocyte count is
below 150 cells per cubic millimetre in patients who have had opportunistic diseases
Serum levels of both clarithromycin and rifabutin increase when taken with fluconazole
Once the MAC disease occurs antimycobacterial treatment with a combination of drugs is required.